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The emergency department care of a child with autism spectrum disorder (ASD) can be difficult due to problems with communication, social interaction and the patients problems with dealing with change. The often loud, hectic and unfamiliar environment does not help either. Avoiding triggers, dimming lights, quiet rooms, using distractions and using home electronic devices may help. Despite these interventions, these children may still require some type of sedation, even to be able to complete a routine exam. There is not much research on ED sedation practices in this population.
The study cited was a retrospective chart review of 6020 patients with ASD seen over 8 years. 126 patients required sedation. Laceration repair (24.6%), incision and drainage (17.5%), diagnostic imaging (14.3%) and physical exam (11.9%) were the leading reasons for sedation. Half of the children received ketamine and half received midazolam. Adverse effects were seen in 18% of patients with vomiting and desaturations being the most common. Sedation was inadequate in 4 patients who received midazolam alone. Physical restraint was used to complete some procedures due to patient resistance.
The use of sedation for painless procedures and exams is likely a consequence of communication impairments and sensory aversions.
References
Brown et al. Procedural sedation in children with autism spectrum disorders in the emergency department. Am J Emerg Med. 2019 Aug;37(8):1404-1408.